Unpacking the Multi-level Drivers of Cardiotoxicity Disparities in Breast Cancer Survivors

摘要 乳腺癌生存率的提高部分是由于治疗的改善。但这些 治疗并非没有轻微到危及生命的副作用。例如，蒽环类化疗（例如， 阿霉素）和人表皮生长因子受体-2（HER-2）靶向疗法已显示 导致心脏毒性（CTX）或心脏损伤。这种副作用是非常令人关注的，因为幸存者 可能死于心脏病的人数比任何其他诊断都多， CTX与心脏相关死亡风险已被证明有助于心脏毒性的因素包括黑色 种族和合并症。虽然心血管疾病文献包括以下作用： 普遍存在的心理社会和社会文化因素以及表现形式上的种族差异， 进展，这些因素在CTX的背景下是未探索的。此外，癌症护理提供因素，包括 CTX的维持值得关注，因为可能有机会解决护理方面的差距或差异 这可能会加剧CTX差异。解决心理社会和社会文化因素， 干预目标是缓解CTX差异。以社会生态模型为指导，进行 回顾性分析和历史-前瞻性队列研究，以确定与种族差异相关的因素 在CTX。在K99指导阶段，我将提取接受治疗的乳腺癌幸存者的电子医院数据 蒽环类药物化疗或Her-2靶向治疗，以阐明社会人口统计学、临床和 与CTX发作和种族差异相关的维持因素（目的1）。在目标2中，我将深入开展 与黑人和白色幸存者（n=20）进行了访谈，以了解心理社会和 可能导致CTX的社会文化经历。在R 00阶段（目标3），我将使用 从深入访谈中了解到，将分发给n=150名黑人和白色乳房的调查 接受辅助治疗的癌症幸存者。这项调查，加上医疗记录数据，将 用于评估心理社会和社会文化因素与CTX种族差异之间的关系。 为了成功地实现这些目标，候选人将接受癌症护理提供的战略规划， 心脏肿瘤学和混合方法研究。这些培训目标将确保候选人的目标， 成功地过渡到独立，并建立了一个研究计划，涉及发展 这些干预措施将解决癌症护理提供和结果中的种族差异。的专门知识和 除了丰富的资源和对培训的承诺之外，还需要指导和咨询小组的指导 通过制度环境提供的将确保候选人的研究项目的成功， 过渡到独立。

Abstract The improvement in breast cancer survival is partially due to improvements in treatments. However, these treatments are not without mild to life-threatening side effects. For example, anthracycline chemotherapies (e.g. doxorubicin) and human epidermal growth factor receptor-2 (HER-2) targeted therapies have been shown to cause cardiotoxicity (CTX), or damage to the heart. This side effect is of great concern as survivors are more likely to die of heart disease than any other diagnosis and racial disparities exist with regard to prevalence of CTX and risk of heart-related mortality. Factors that have been shown to contribute to cardiotoxicity include Black race and the presence of comorbidities. While the cardiovascular disease literature includes the roles of psychosocial and sociocultural factors in its prevalence and the racial disparity in its manifestation and progression, these factors are unexplored in the context CTX. Additionally, cancer care delivery factors, including maintenance of CTX, deserves attention as there may be opportunities to address gaps or differences in care that may exacerbate the CTX disparity. Addressing psychosocial and sociocultural factors may provide intervention targets to mitigate CTX disparities. Guided by the Social Ecological Model, I will conduct retrospective analyses and a historical-prospective cohort study to identify factors related to the racial disparity in CTX. During the K99 mentored phase, I will abstract electronic hospital data on breast cancer survivors treated with anthracycline chemotherapy or Her-2 targeted therapies to elucidate sociodemographic, clinical, and maintenance factors that relate to onset of and racial differences in CTX (Aim 1). In Aim 2, I will conduct in-depth interviews with Black and White survivors (n=20) with and without CTX to understand psychosocial and sociocultural experiences that may contribute to CTX. During the R00 phase (Aim 3), I will use the information learned from the in-depth interviews to inform a survey that will be distributed to n=150 Black and White breast cancer survivors who were treated with adjuvant therapies. This survey, coupled with medical record data, will be used to assess relationships between psychosocial and socio-cultural factors and racial differences in CTX. In order to successfully execute these aims the candidate will receive strategic planning in cancer care delivery, cardio-oncology, and mixed methods research. These training aims will ensure the candidate's goal of successfully transitioning to independence and establishing a research program involving the development of interventions that will address racial disparities in cancer care delivery and outcomes. The expertise and guidance of the mentoring and advisory teams in addition to the wealth of resources and commitment to training provided through the institutional environment will ensure the success of the candidate's research project and transition to independence.